Am J Gastroenterol. The high level of heterogeneity in MACE could be due to the different criteria for the composite outcome, with many studies having little overlap in the criteria to constitute a MACE compared to others Table 1. Given the well-known limitations of observational studies, these results should be interpreted with caution. On the other hand, the United States Food and Drug Administration and the European Medicines Agency revised the labelling of clopidogrel, which now mentions that omeprazole and esomeprazole should be avoided in patients treated with clopidogrel, that other acid-lowering agents with minimal or no inhibitory effects on CYP2C19 should be considered and that lansoprazole and pantoprazole have less inhibitory effect on the antiplatelet action of clopidogrel than omeprazole and esomeprazole[ 3940 ]. The results of this study support limiting concomitant therapy following PCI to individuals at increased risk of gastrointestinal bleed where gastrointestinal protection could outweigh the risk of increased cardiovascular events. Indeed, some studies reported that PPI use is associated with increased risk for cardiovascular events regardless of the use of clopidogrel and in patients treated with ticagrelor, which does require activation by CYP2C19, suggesting that PPI use is a marker of increased cardiovascular risk and frailty[ 12303233 ].
Video: Plavix and ppi interaction jamarcus Heart Minute - Pantoprazole Lacks Clopidogrel Interaction
In August Medsafe advised prescribers it was reviewing a possible interaction between clopidogrel and proton pump inhibitors (PPIs). This review followed. Other proton pump inhibitors do not appear to interact with clopidogrel.
Nevertheless, given the limitations of existing observational and. To synthesize the evidence of the effect of clopidogrel-PPI drug interaction on adverse cardiovascular outcomes in a PCI patient population.
Coron Artery Dis. Tentzeris et al. References: 1. Conflict-of-interest: We have no conflict of interest to declare. Effects of PPIs and an H2 blocker on the antiplatelet function of clopidogrel in Japanese patients under dual antiplatelet therapy.
Risk of adverse clinical outcomes with concomitant use of clopidogrel and proton pump inhibitors following percutaneous coronary intervention.
Clinical relevance of clopidogrelproton pump inhibitors interaction
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|External link. Pharmacodynamic effects of concomitant versus staggered clopidogrel and omeprazole intake: results of a prospective randomized crossover study.
Even though clopidogrel is safer than aspirin in terms of risk for gastrointestinal GI bleeding, the elderly, and patients with a history of prior GI bleeding, with Helicobacter pylori infection or those who are also treated with aspirin, anticoagulants, corticosteroids or nonsteroidal anti-inflammatory drugs are at high risk for GI complications when treated with clopidogrel.
Video: Plavix and ppi interaction jamarcus Gastroenterology Controversies: Long Term Safety of Proton Pump Inhibitors
In conclusion, even though pharmacodynamic studies suggest that omeprazole can attenuate the antiplatelet effect of clopidogrel, this interaction does not appear to translate into increased cardiovascular risk in patients treated with this combination. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.
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Aliment Pharmacol Ther. Moreover, the risk of GI bleeding further increases in patients who receive clopidogrel in combination with aspirin as well as in the elderly, in patients with a history of prior GI bleeding or with Helicobacter pylori infection, and in those who are also treated with anticoagulants, corticosteroids or nonsteroidal anti-inflammatory drugs NSAIDs [ 78 ].
Abstract Clopidogrel is a widely used antiplatelet agent for the secondary prevention of cardiovascular events in patients with stable coronary heart disease, acute coronary syndromes and ischemic stroke.
Meta-analyses have shown an increased risk of major adverse cardiovascular events with concomitant therapy, but none have focused on exclusively on high-risk PCI patients. In light of these conflicting data, the American Heart Association, American College of Cardiology and the American College of Gastroenterology issued an expert consensus document recommending that PPIs should be considered only in those patients treated with clopidogrel who are at high-risk for GI bleeding, including those with a previous history of GI bleeding, with Helicobacter pylori infection, who are treated with NSAIDs, corticosteroids or anticoagulants, and the elderly[ 16 ].
Zou et al. Concomitant use of clopidogrel and proton pump inhibitors is not associated with major adverse cardiovascular events following coronary stent implantation.
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Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: An analysis of two randomised trials. Major observational studies that evaluated the effects of coadministration of clopidogrel and proton pump inhibitors on cardiovascular events. Meta-analyses have shown an increased risk of major adverse cardiovascular events with concomitant therapy, but none have focused on exclusively on high-risk PCI patients.
Table 1: Study Characteristics. Author manuscript; available in PMC Sep